AccountId: 011433970860
ContactId: d4cdacfa-9337-4053-89f9-b3eae3d7c76e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296040 ms
Total Talk Time (AGENT): 134094 ms
Total Talk Time (CUSTOMER): 111507 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/d4cdacfa-9337-4053-89f9-b3eae3d7c76e_20250128T14:09_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from doctor's office. I have a patient. I want to check eligibility and benefits for specialist office visit. Can you please help me?
[AGENT][NEUTRAL] Sure, I can assist you with the eligibility and benefits, Mr. [PII]. May I have a callback number just in case we get disconnect them?
[CUSTOMER][NEUTRAL] Yes, it's [PII], direct line?
[AGENT][NEUTRAL] Thank you. And may I have uh the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the patient, uh, uh, it's the outpatient benefits card number is, it's 01829134 M like Mary, L like Lima 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, the official name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, and you said you need eligibility and benefits and this is for a specialist office visit, correct?
[CUSTOMER][POSITIVE] Yes, of of course.
[AGENT][NEUTRAL] OK, right, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. We have an effective date of [PII].
[AGENT][NEUTRAL] It is active at the moment and this is one of our secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] For the benefits, um, we have, let's see, we cover the office treatments or office procedures. We do not cover the office visit. The office treatments or procedures are subject to the outpatient maximum which is $500 per day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] $500. OK. OK, means the office procedures and office treatments are covered, but the office visit is not covered, am I correct?
[AGENT][POSITIVE] Correct, yes, mhm.
[CUSTOMER][NEUTRAL] OK. And uh I also want to know that if uh primary insurance, patient primary insurance left some responsibility as, as a co-pay or deductible or co-insurance, uh then uh uh as a secondary APL covers it.
[AGENT][NEUTRAL] If it's a cover service, like in this case, if it's an office treatment or procedure, it will be covered. If it's uh for the office visit, it will not be covered, it will be denied.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][POSITIVE] OK, thank you so much. Also please confirming the electronic payer ID for your information.
[AGENT][NEUTRAL] OK, um, with this one we need the claim to be faxed or mailed because we need the explanation of benefits attached to it, uh, the primary explanation of benefits, um, but, um, for your records I can give you the payer ID which is 60801.
[CUSTOMER][NEUTRAL] 0801 OK and also confirm me the mailing address and fax number as well.
[AGENT][NEUTRAL] Sure, the fax number is [PII].
[CUSTOMER][NEUTRAL] OK, also give me the mailing address.
[AGENT][NEUTRAL] Sure, that is [PII].
[AGENT][NEUTRAL] [PII], [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Now, the patient is active and it will covers office treatments and office infusions, not covers the office visit. And uh it also covers the uh left responsibility from the primary, not the office visit. Uh, am I correct?
[AGENT][NEUTRAL] Correct, it will cover copayments, co-insurance, and deductibles from the major medical, not including the office visit co-pay.
[CUSTOMER][POSITIVE] OK, thank you so much. Give me the call reference number kindly.
[AGENT][NEUTRAL] We don't have reference numbers, Mr. [PII]. You can use my name in today's date if you will. Do you need the spelling or any other information?
[CUSTOMER][NEUTRAL] OK. Can you please spell your name for me?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], for providing me that useful information. Thank you so much. Have a nice day. Take care.
[AGENT][POSITIVE] You're welcome. You as well, Mr. [PII] and thank you for calling APL. Bye bye.